Kidney Transplantation Improves Survival in Antineutrophil Cytoplasmic Antibody–Associated Vasculitides With End-Stage Kidney Disease

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2025-05-01 DOI:10.1016/j.ekir.2025.02.001

Benoît Brilland , Jean-François Augusto , Thomas Jouve , Noémie Jourde-Chiche , Cécile Couchoud , Renal Epidemiology and Information Network (REIN) registry

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Abstract

Introduction

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) frequently leads to end-stage kidney disease (ESKD). Although kidney transplantation (KT) is considered the optimal treatment for ESKD, its survival benefit in patients with AAV remains understudied. This study aimed to determine the impact of KT on survival in waitlisted patients with AAV-induced ESKD (AAV-ESKD).

Methods

We conducted a retrospective analysis of patients with AAV-ESKD registered in the French Renal Epidemiology and Information Network (REIN) registry and waitlisted for KT between 2002 and 2022. KT was treated as a time-dependent variable to avoid immortal time bias. Survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models, adjusting for key demographic and clinical factors. Subgroup analyses were conducted based on vasculitis type, age, sex, and year of ESKD onset.

Results

Of 1165 patients with AAV-ESKD, 468 (40%) were waitlisted, and 318 of these (68%) received a transplant. After a median follow-up of 61 months after waitlisting, KT was associated with a 53% reduction in mortality risk (adjusted hazard ratio [HR] = 0.47 [0.31–0.73], P < 0.001). This benefit was consistent across subgroups. Patient survival at 10 years was 72% for transplant recipients versus 28% for nontransplanted patients (P < 0.001). Sensitivity analyses, after excluding recipients of living donors and patients removed from the waitlist supported the robustness of these findings. Within 2 years from ESKD onset, 24% of waitlisted patients were transplanted. Graft failure probability was 22% at 10 years posttransplant.

Conclusion

KT is associated with a significant survival benefit in waitlisted patients with AAV-ESKD compared with waiting on dialysis. These findings emphasize the importance of timely transplant evaluation and improved access to KT for this population.

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肾移植可提高抗中性粒细胞细胞质抗体相关血管增生终末期肾病患者的生存率

抗中性粒细胞细胞质抗体（ANCA）相关血管炎（AAV）经常导致终末期肾脏疾病（ESKD）。尽管肾移植（KT）被认为是ESKD的最佳治疗方法，但其在AAV患者中的生存益处仍未得到充分研究。本研究旨在确定KT对aav诱导ESKD （AAV-ESKD）等待患者生存的影响。方法回顾性分析2002年至2022年间在法国肾脏流行病学和信息网络（REIN）登记并等待KT的AAV-ESKD患者。KT被视为时间相关变量，以避免不朽的时间偏差。采用Kaplan-Meier分析和Cox比例风险模型评估生存率，并对关键的人口统计学和临床因素进行调整。根据血管炎类型、年龄、性别和ESKD发病年份进行亚组分析。结果在1165例AAV-ESKD患者中，468例（40%）在等待名单中，其中318例（68%）接受了移植。在等待名单后的中位随访61个月后，KT与死亡风险降低53%相关(校正风险比[HR] = 0.47 [0.31-0.73], P <；0.001)。这种益处在各个亚组中是一致的。移植患者10年生存率为72%，非移植患者为28% (P <；0.001)。在排除活体供体接受者和从等待名单中移除的患者后，敏感性分析支持了这些发现的稳健性。ESKD发病后2年内，24%的等候患者接受了移植。移植后10年移植失败的概率为22%。结论与等待透析的AAV-ESKD患者相比，kt与显著的生存获益相关。这些发现强调了及时移植评估和改善这一人群获得KT的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.